(1155) Continuous Positive Airway Pressure Versus High-Flow Nasal Cannula for Hypoxic Respiratory Failure

Introduction: Patients with acute hypoxic respiratory failure are frequently treated with non-invasive respiratory strategies, such as continuous positive airway pressure (CPAP) or high flow nasal cannula (HFNC). Randomized controlled trials (RCTs) comparing the efficacy of these two modalities have demonstrated conflicting results. We conducted a meta-analysis to better understand outcomes associated with these therapies.

Methods: We searched multiple online databases for RCTs comparing CPAP to HFNC for treatment of hypoxic respiratory failure. The outcomes of interest were intubation rate within 1 month, mortality rate within 1 month, ventilator free days and duration of hospitalization. We calculated pooled odds ratio (OR) and standardized mean difference (SMD), along with 95% confidence interval (CI) using a random-effects model. We used the I² statistic to determine heterogeneity between studies.

Results: Six RCTs with a total of 1,546 patients (CPAP n=775, HFNC n=771) were included. The mean age was 62 years, 67% patients were men and the mean duration of follow up was 44 days. As compared to HFNC, patients in the CPAP group had a significantly lower likelihood of intubation within 1 month (OR 0.73, 95% CI 0.57 to 0.93, p = 0.01, I² = 0%). There were no significant differences between the CPAP and HFNC groups with regards to mortality within 1 month (OR 1.03, 95% CI 0.63 to 1.69, p = 0.91, I² = 37%) and ventilator free days (SMD 2.05, 95% CI -3.62 to 7.73, p = 0.48, I² = 99%). CPAP was associated with longer duration of hospitalization (SMD 0.27, 95% CI 0.05 to 0.50, p = 0.02, I² = 0%).

Conclusions: This meta-analysis shows significant reduction in the likelihood of intubation in patients treated with CPAP as compared to HFNC for hypoxic respiratory failure, without any differences in mortality.